Our care management applications support the medical management activities conducted across the care continuum. Health plans, employers, and third-party administrators optimize member outcomes enabled by tools that support case management, disease management, population health, utilization management, advocacy, and wellness programs.Get Started
Case managers utilize our applications to focus on care coordination, financial management and resource utilization to yield cost-effective outcomes that are patient-centric, safe and provided in the least restrictive setting. Our case management tool-set enables nurses and other licensed professionals to meet health outcome and cost containment goals under value-based care and payment agreements.
Plan administrators can monitor authorization requests (inpatient, services and pharmacy) for all plan members. The application serves as the source of truth for all attachments sent by the provider for the request. Other features include: the ability to conduct initial authorization and continued stay reviews for inpatient authorizations; the ability to do approval, denial, carve outs of days requested; the ability to link directly to evidence based criteria from InterQual or MCG; the ability to communicate/document on secondary reviews; the ability to generate letters of decisions to multiple places (member, provider, facility) based on business needs; and the ability to handle appeals and grievances.
Effectively and proactively coordinate care with 360° member views and built-in clinical insights, including gap-in-care alerts and risk scores to support early identification and intervention of at-risk members of the cohort. Cohorts of members that meet certain criteria can be created (in Plan Analytics) and monitored in real time (from Plan Analytics or the care management application). Cohorts can be imported and auto-assigned into queues. Queues can be set up to automatically trigger actions, such as a significant next action, or a program referral for members of the cohort. One example of this would be for all members with diabetes in a cohort to be automatically referred to or enrolled in a diabetes management program.
Patient-Member engagement can be managed by administering incentive-based programs, tracking progress towards goals and allocating rewards upon completion. The incentive management application is shared between the member and the care team, so everyone is aligned around the care plan, the member’s goals, and progress towards them.
The Provider Portal allows providers to submit requests for inpatient, service/procedure and pharmacy authorizations for a member. Once submitted, the request is acted on by the care management team member and the requesting provider receives a response indicating whether the response is approved, pending, or denied. The provider can view both current and historical information on submitted and completed authorization requests related to the member.
Those responsible for improving health outcomes need a simple way to proactively manage member health across the entire spectrum of care. The member Health Portal serves as an extension of Plan Analytics, seamlessly integrating and organizing healthcare data to deliver individualized information that supports members in taking action to meet their personal health goals and allows for more effective member communications.
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Cedar Gate’s enterprise performance management analytics and administration platforms reduce risk, enhance financial performance, and improve patient outcomes for healthcare organizations across the value-based care continuum.
Capture, organize, and utilize all valuable data sets securely and easily.EXPLORE
Empower your team with timely information to take action and reach performance goals.EXPLORE
Transform the way you report on your business with these intelligent tool sets.EXPLORE
Manage patients effectively from chronic conditions to transitions of care.EXPLORE
Administer retrospective and prospective bundled payment arrangements with clinical excellence.EXPLORE
Operate multiple lines of business with claims and benefits administration, eligibility, capitation reconciliation, financial management and more.EXPLORE
Extend your effectiveness with managed, professional, or advisory services.EXPLORE